Healthcare Provider Details

I. General information

NPI: 1295916468
Provider Name (Legal Business Name): FLORIDA BACK INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 CLINT MOORE RD SUITE 309
BOCA RATON FL
33496-2661
US

IV. Provider business mailing address

1905 CLINT MOORE RD SUITE 309
BOCA RATON FL
33496-2661
US

V. Phone/Fax

Practice location:
  • Phone: 561-988-8988
  • Fax: 561-912-1804
Mailing address:
  • Phone: 561-988-8988
  • Fax: 561-912-1804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY C FERNYHOUGH
Title or Position: PRESIDENT
Credential: MD
Phone: 561-988-8988